Cost-effectiveness of malaria control in sub-Saharan Africa
Cost-effectiveness of malaria control in sub-Saharan Africa
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DOI：
10.1016/s0140-6736(99)02141-8
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发表时间：
1999-07-31
期刊：
影响因子：
168.9
通讯作者：
Mills, AJ
中科院分区：
文献类型：
--
作者：
Goodman, CA;Coleman, PG;Mills, AJ
世界卫生组织减少疟疾运动需要关于疟疾控制成本效益的背景信息，但很少。我们使用数学模型计算撒哈拉以南非洲主要预防和治疗措施的成本-效果比。方法我们分析了预防儿童疟疾(驱虫蚊帐、房屋残留喷洒和化学预防)和怀孕(氯喹化学预防和磺胺多辛-乙胺间歇治疗)以及改善疟疾治疗(改善依从性、改善二线和三线药物的可获得性以及改变一线药物)的干预措施。我们开发了包括概率敏感性分析的模型，以计算三个经济阶层中每次干预所避免的每残疾调整生命年成本(DALY)的范围。在一个极低收入国家，现有蚊帐的杀虫剂处理费用为4-10美元；提供蚊帐和杀虫剂处理费用为19-85美元；残留喷洒(每年两轮)为32-58美元；儿童化学预防费用为3-12美元(假设有现有的递送系统)；孕妇间歇治疗费用为4-29美元；改善病例管理费用为1-8美元。虽然有些干预措施费用不高，但通过预防儿童疟疾的干预措施实现高覆盖率将占用当前卫生保健支出的很大比例。一揽子干预措施：然而，在极低收入国家，减轻大部分疟疾负担是负担不起的。覆盖非洲最弱势群体将需要外部捐助者提供大量援助。
Background Information on the cost-effectiveness of malaria control is needed for the WHO Roll Back Malaria campaign, but is sparse. We used mathematical models to calculate cost-effectiveness ratios for the main prevention and treatment interventions in sub-Saharan Africa.Methods We analysed interventions to prevent malaria in childhood (insecticide-treated nets, residual spraying of houses, and chemoprophylaxis) and pregnancy (chloroquine chemoprophylaxis and sulfadoxine-pyrimethamine intermittent treatment), and to improve malaria treatment (improved compliance, improved availability of second-line and third-line drugs, and changes in first-line drug). We developed models that included probabilistic sensitivity analysis to calculate ranges for the cost per disability-adjusted life year (DALY) averted for each intervention in three economic strata. Data were obtained from published and unpublished sources, and consultations with researchers and programme managers.Findings In a very-low-income country, for insecticide treatment of existing nets, the cost-effectiveness range was US$4-10 per DALY averted; for provision of nets and insecticide treatment $19-85; for residual spraying (two rounds per year) $32-58; for chemoprophylaxis for children $3-12 (assuming an existing delivery system); for intermittent treatment of pregnant women $4-29; and for improvement in case management $1-8. Although some interventions are inexpensive, achieving high coverage with an intervention to prevent childhood malaria would use a high proportion of current health-care expenditure.Interpretation Cost-effective interventions are available. A package of interventions:to decrease the bulk of the malaria burden is not, however, affordable in very-low-income countries. Coverage of the most vulnerable groups in Africa will require substantial assistance from external donors.